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Tuesday, December 1, 2009

Spine: The Brave New World

TSB had a dystopian nightmare last night! It was Quixotic., farcical, yet serious. It was in black and white, and it was about a futuristic world called spine. A brave new world, intrigued with science and medicine, yet absorbed with survival. No longer were companies, surgeons, patients, distributors and sales people in control of their destiny. They had become slaves to their master. Their vice was greed, and their master was Wall Street, aka the Toecutter. As a result of our greed, there was a divergent path of social, financial, scientific, and medical progress. I saw the future, a future that was a by product of our industry's DNA. I saw the initial cracks in the foundation of what once was a noble and honorable industry. It became an industry that sought to minimize everyone's ability to earn an honest living, and be equitably compensated for their efforts.

I dreamt that surgeons were no longer doctors, they were now working under cover as silent partners in distributorships across the vast tundra know as the U.S. market, frozen in time, seeking to make as much money as they could, because being a surgeon was no longer an honorable profession. There were no morals, no ethics, no soundness of character. No longer were people hired for their talent, the industry became a nepotistic society. Distributors had became the Road Warriors of the industry, no longer working in a civil society, it was an apocalyptic future in the wasteland of spine products. Outlaw gangs defying social order primarily because work had no value.

It's a couple of years into the future, 40% commissions are a thing of the past. You are working for 15% commissions on top of paying your own expenses. There are more deals than Max Rockatansky could handle. The industry is ruled by violent gangs known as the Nightrider (the Spine Cartel) who have turned the industry into a battle ground of survival. Free markets are nothing more than a state of mind, an opiate to dull your senses. Yes readers, you know what I am talking about because we experience it everyday. It's a world where companies no longer play by rules, they make the rules like paint by number dreams, expecting immediate results, sound familiar Wall Street? How quick can you bring me $3 million in revenue? What surgeons can you buy? Whose business can you steal? Sounds familiar? What could we expect when these miscreants have either forgotten what it takes to build a business or have never built a business?

Yes readers we have become slaves to the Street! Unfortunately, the Street doesn't care about anyone prospering but themselves. It's all about short-term prosperity rather than long-term viability. And then I rolled over, woke up in a cold sweat and realized that it was just a bad dream.

Unfortunately, it is the cold reality. I know of five surgeons who are owners of a distributorship. Service is only a memory. Yes, it is all about relationships. Relationships based on dead presidents.

This is the worst market for medical devices I've ever seen. Exclusive contracts don't mean anything anymore. Our base tissue line sells to ghost distributorships which in turn cross any state line to locate individual reps which in turn sell to the surgeon that I am trying to service. Who needs a beeper when this becomes the norm? There is no service, there is no exclusivity, there is no loyalty. This my friends, is all b.s. They'll miss us when we're gone...

I am an independent representative and I love and enjoy what I do. That said, what I can do is limited due to the nature of the spine landscape. A backhanded slap from a company, hospital and/or surgeon is a common theme. Companies are hiring direct reps and multiple distributors to sell the same product. Hospitals want "Value Meal" pricing and I have to pay a $20 dollar parking fee. Surgeons are consultants and owners of the implant company if not the surgery center. Have we hit the bottom, or will the other side of the knife slice my throat. Happy Holidays.

The only thing I don't like about this thread is the implication that this is so widespread, that it is happening in every city and clinic in America. While I know that many of these things are happening, I don't think it is the norm and I don't think it is as widespread as it is portrayed.

I would also tread cautiously on the difference between what are perceived to be routine conflicts, versus actual conflicts that break laws or are very bad business practices. One is a reputation thing, the other is a go-to-jail thing.

Call me an optimist, but I think that as the microscope of scrutiny and full disclosure increases (new state laws, Sunshine Act, NASS disclosures, etc.) many will come to their senses about the perception of conflicts issue and realize it isn't worth their reputation. And for the ones where they are breaking laws (which I don't know of any, only implied), may they get rapid and sound legal advice and unwind whatever it is that may be in breach.

Dum Duh Rum Dum! ...... Dum Duh Rum Duh!...... Dum The story you're about to hear is true, the names have been changed to protect the innocent! Optimist, do you really believe that, or are you attempting to convince yourself that there is a light at the end of the tunnel?

What is the alternative if the increased scrutiny does not change the perception of conflicts issue? Well, then we will invite more laws, investigations, etc. to the point that what is now gray, will become black and shift into the realm of illegal.